支架内再狭窄--IVUS.ppt

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1、IVUS指导下处理支架内再狭窄1例IVUS-GuidedPCIforthePatientwithISR浙江省中医院心内科蔡宏文HistorySummary67yearoldmalePresentedwithdevelopedrecurrentchestpainatrestIn2009,RCAstentsforoldinferiormyocardialinfarction(7monthsago)andunstableanginaIn2010,repeatPCIforRCAandLADbecauseofunstableanginaHistoryo

2、fDislipidemiaandhypothyroidism,smokerDiagnosis:unstableanginaAngiographyofOct29,20092.0×15mmsprinter10atmRCAPredilatation1.5×15mmsprinter8atm3.0×30mmEndeavor14atmRCAStenting3.0×30mmEndeavor12atmFinalAngiographyAngiographyofMar15,2010RCAandLADStenting3.0×13mmFirebird12atm3.0

3、×18mmFirebird12atmFinalAngiographyAngiographyofFeb11,2015RCAIVUSMLA=2.51mm2RCAIVUSProximalUnderexpansion?DistalDistalreferenceDistalstentMidstentProximalstentProximalreferenceRCAIntervention2.5×15mmMaverick10atm2.75×17mmSeQuentPleaseDCB14atm40sFinalAngiographyRCAFinalIVUSML

4、A=4.09mm2DefinitionUseofIVUSinISREvaluationforthepatternsandmechanismGuidethetreatmentselectionsImportanceofIVUSforISRAngiographicISRClassificationconfirmedbyIVUSMehran,etal.Circulation.1999;100:1872-1878(<10mm)(>10mm)MechanismsofDESRestenosisVasimFarooq,etal.ThePCR-EAPCITe

5、xtbook–PercutaneousInterventionalCardiovascularMedicineIn-stentRestenosis.FindingsofIVUSforISRStentUnderexpansion:FinalStentArea：MSA≤5mm2,StentlengthStentEdgeRestenosisStentFractureDESGaporGeographicMiss(Incompletestentcoverage)Non-UniformStentExpansion:Non-uniformStrutDist

6、ribution，DESDamageIntimalHyperplasiaBalloonPTCA(also"Cutting"Balloon)Drug-CoatingBalloonsDrug-ElutingStents(DES):SameorDifferent?BioresorbableScaffordBareMetalStent(BMS)Brachytherapy(VBT)Rotablation(RA)/LaserMedicalManagementCABGTreatmentOptionsofDESISRStrategiesforISRTreat

7、mentDCBorDESSummaryCurrentrestenosisratesarelowerthaneverbutcanstillpresentachallengeWewilltreatrestenosisdifferentlybaseduponthemechanismThecurrentmaincauseofISRisstentunderexpansionindifficultlesionssuchascalcified,long,smallvesselsForcomplexlesions,IVUSguidedtailor-madeP

8、CIstrategyisimportantTHANKYOU